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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (08) : 618 -625. doi: 10.3877/cma.j.issn.1672-6448.2017.08.010

所属专题: 文献

妇产科超声影像学

连续顺序追踪超声法诊断早中孕期胎儿肢体异常及图像分析
魏卓君1, 田瑞霞1,(), 朱有志2, 胡勇3   
  1. 1. 230031 合肥,解放军第一〇五医院妇产超声科
    2. 230031 合肥,解放军第一〇五医院放射科
    3. 230031 合肥,解放军第一〇五医院病理科
  • 收稿日期:2017-02-07 出版日期:2017-08-01
  • 通信作者: 田瑞霞
  • 基金资助:
    南京军区医学科技创新重点课题(15ZD015)

Analysis on cases of fetus limb deformity using systematic continuous sequence approach during early and middle pregnancy

Zhuojun Wei1, Ruixia Tian1,(), Youzhi Zhu2, Yong Hu3   

  1. 1. Department of Ultrasound, the 105th Hospital of Chinese People′s Liberation Army, Hefei 230031, China
    2. Department of Pathology, the 105th Hospital of Chinese People′s Liberation Army, Hefei 230031, China
    3. Department of Radiology, the 105th Hospital of Chinese People′s Liberation Army, Hefei 230031, China
  • Received:2017-02-07 Published:2017-08-01
  • Corresponding author: Ruixia Tian
  • About author:
    Corresponding author: Tian Ruixia, Email:
引用本文:

魏卓君, 田瑞霞, 朱有志, 胡勇. 连续顺序追踪超声法诊断早中孕期胎儿肢体异常及图像分析[J]. 中华医学超声杂志(电子版), 2017, 14(08): 618-625.

Zhuojun Wei, Ruixia Tian, Youzhi Zhu, Yong Hu. Analysis on cases of fetus limb deformity using systematic continuous sequence approach during early and middle pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(08): 618-625.

目的

对胎儿常见肢体畸形及少见复杂肢体畸形(海豹肢和人体鱼序列综合征)胎儿产前超声声像图特征进行总结分析。

方法

采用连续顺序追踪超声法对2014年9月至2016年8月在解放军第一〇五医院产前超声筛查的18 708例胎儿行常规肢体和手足检查。与引产胎儿外观、影像检查及尸检结果对照,总结胎儿肢体畸形产前超声声像图特征。

结果

产前常规和系统超声筛查检出胎儿肢体畸形76例(0.41%,76/18 708),包括:(1)前臂及手部畸形2例;缺指、多指、并指等手指数目异常11例;裂手畸形2例;手缺如2例;手姿势异常7例;(2)下肢及足部畸形:足内翻45例,海豹肢2例,人体鱼序列综合征1例;(3)四肢短小4例。其中孕14~19+6周胎儿肢体畸形超声检出率为0.69%(18/2627),孕20~27+6周超声检出率为0.46%(38/8195),孕20~27+6周超声检出率为0.40%(17/4237),均高于孕11~13+6周超声检出率(0.08%,3/3649)。76例肢体畸形胎儿中合并其他系统异常37例(包括颅脑、心脏、消化、肾脏、头面部及脊柱等);其中染色体异常11例(21-三体2例,18-三体6例,13-三体3例)。76例肢体畸形引产胎儿标本外观检查均与产前超声检查结果一致,尸检(64例)证实产前超声仅遗漏1例胎儿左足多趾畸形。

结论

早中孕期采用连续顺序追踪超声法筛查胎儿四肢及指趾,可及早发现胎儿肢体畸形,为临床处理提供诊断依据。

Objective

To summarize prenatal two-dimensional ultrasound examination results of different types of fetal limb deformity, and emphasise on some rare deformity disease such as phocomelia and sirenomelia. To investigate the value of systematic continuous sequence approach in the examination of fetal limb during pregnancy periods.

Methods

Eighteen thousand seven hundred and eight cases of fetus were selected from September 2014 to August 2016 in the 105th Hospital of Chinese People′s Liberation Army, which were screened by routine and systematic ultrasonography. The systematic continuous sequence approach was used to focus on examination of the fetal limb. All fetuses with abnormal limbs were followed up. The ultrasonographic images were compared with the results of pathological examination and X-ray examination to summarize the ultrasonographic features of fetal limb deformities.

Results

Seventy-six cases of fetal limb deformity were detected by prenatal ultrasound system in 18 708 cases. Three cases were detected at 11-13+ 6 weeks of gestation, 18 at 14-19+ 6 weeks, 38 at 20-27+ 6 weeks, 17 at 28-35+ 6 weeks. Types of limb deformities are as fllowing, 11 cases of abnormal number of fingers (adactylism, polydactyly, syndactyly), 2 cases of cleft hand deformity, 45 cases of foot varus, 1 case of sirenomelia and 4 cases of short limbs. Thirty-seven cases of fetal limb deformity combined with other system malformations and 12 cases were with multiple system malformations. Karyotypes were abnormal in 11 cases, including 3 cases of trisomy 21, 6 cases of trisomy 18 and 3 cases of trisomy 13. One case of prenatal ultrasound diagnosis of twins with sirenomelia. An autopsy of twin fetus indicated that there were epactal toes at the left foot. Prenatal ultrasonography.

Conclusions

The systematic continuous sequence approach in early and middle pregnancy play the advantages of each pregnancy examination. The fetal limb deformity can be detected early by combining application of systematic continuous sequence approach.

图1~3 膈疝及手畸形胎儿产前超声声像图及引产标本手部畸形外观图。孕妇31岁,孕1产0,孕13+6周产前检查胎儿颈项透明层,1.4 mm;胎儿心脏向右移位;连续观察胎儿腹腔内未见胃泡,部分胃肠道回声似穿过膈肌;图1二维超声膈肌斜冠状切面示:胎儿腹腔内未见胃泡显示,胃泡大部分位于膈肌下方,小部分胃肠道回声似穿过膈肌,位于胸腔(箭头所示);图2二维超声右手冠状切面示:胎儿右手食指与中指间距增宽,拇指未显示;孕23周系统超声检查结果与13+6周初次诊断结果一致;图3胎儿标本双手外观示:右手仅四根手指,桡侧第一根手指较长,姿势异常呈内收屈曲状,余三根手指呈半握状;左手形态未见明显异常
图4~8 孕27周肢体畸形胎儿产前产后影像图及引产胎儿手部畸形外观图。图4二维超声上肢长轴切面示:上肢肱骨未显示,尺、桡骨直接与肩胛骨相连(箭头所示);图5三维超声骨骼模式右手冠状切面示:右手仅显示四根手指,未见大拇指(箭头所示);图6二维超声彩色多普勒标准心尖四腔心切面示:心胸比例增大,仅显示单一心房,十字交叉结构显示消失,二、三尖瓣结构异常,仅见一组共同房室瓣,共同房室瓣闭合欠佳,彩色多普勒示共同房室瓣处大量反流;图7孕32周引产胎儿标本X线影像图显示:双侧上肢肱骨缺失,肩胛关节盂处似可见一短小的不规则骨,尺、桡骨直接连接于躯干或通过此不规则骨连接,右手仅四根手指(箭头所示);图8引产胎儿标本病理检查示:双上肢短小,均未见上臂,前臂直接连接于躯干,右手仅四根手指,左手悬垂状姿势(箭头所示)。完全型心内膜垫缺损及部分性海豹肢畸形
图9~14 双胎之一肢体畸形胎儿尸体标本影像图及产后外观图。图9孕31周二维超声胫、腓骨长轴切面扫查示:胎儿双下肢胫、腓骨可见,双下肢并拢(箭头所示);图10二维超声胫、腓骨短轴切面扫查示:胎儿4根小腿骨间距近,软组织融合;图11二维超声足部冠状切面扫查示:胎儿双足根部并拢,皮肤弧形连续,脚掌外翻,呈人体鱼序列综合征表现(箭头所示);图12孕32周胎儿磁共振成像示:双胎妊娠,其一胎儿未见异常,另一胎儿双下肢异常固定于并列伸直位;图13孕37+6周双胎之一死产胎儿标本X线影像示:胎儿双下肢股骨可见,排列尚可,可见4根小腿骨,双侧腓骨位于双侧胫骨内侧,左足多趾;图14死产胎儿标本外观检查示:胎儿双下肢髋部以下肢体融合,双足根部并拢呈"V"形外展,脚掌外翻形似鱼尾,左足多趾。外生殖器、肛门及尿道未见
表1 76例肢体畸形胎儿不同孕周超声检出率[例数(%)]
表2 76例肢体畸形胎儿产前检查结果及妊娠结局[例(%)]
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